Telepsychiatry Practice for Geriatric Patients

In this exclusive video, Psych Congress Network Geriatric Psychiatry Section Editor Marc Agronin, MD, CMO, MIND Institute, Miami Jewish Health, describes his experience treating geriatric patients via telehealth, including the accessibility benefits of virtual practice for the elderly as well as instances where an in-person visit might be most appropriate.

Don't miss these other video insights from Dr Agronin:

The Pros and Cons of Telepsychiatry Practice

What the Data Tells Us About Telepsychiatry Efficacy and Popularity

Want more expert insights on virtual psychiatry? Visit our Telehealth Excellence Forum!

Read the Transcript:

Marc Agronin, MD: Hi, my name is Dr. Marc Agronin. I'm a geriatric psychiatrist. I currently work as the chief medical officer for the Frank C. and Lynn Scaduto MIND Institute at Miami Jewish Health, I also oversee behavioral health there and I've been at Miami Jewish Health for the past 23 years. I'm also the geriatric psychiatry section editor for Psych Congress Network.

Today I'd like to talk to you about telepsychiatry with a focus on older patients in particular.

Now, in my own practice I run a memory disorder center, so everyone who comes to me has some concern or is demonstrating some degree of neurocognitive impairment. Initial visits for some of these individuals is really great because family can participate in sometimes their family members from different cities, different parts of the country, and having all of them able to participate in a session can be really great and gives me a lot more information quicker than previously when everything had to be in person. I can also see people more frequently, individuals who are bed-bound or it's difficult to get out of the house and get there, it's easier for me to see them on a more frequent basis. Some individuals after initial assessment, I need frequent check-ins with them, and so this gives me a way to see them easily. They don't have to come all the way down to the office and set aside part of the day and set up transportation and all the time and cost of that when through telepsychiatry I can see them more readily.

On the other hand, it is more difficult to really assess someone's neurocognitive status when you're doing this via some form of a telepsychiatry platform. It's hard to do neuropsych testing. It's possible, but in my opinion, it's more limited in terms of what you can do it. You can't always get a good sense of the facial expression. It's hard to assess their gait, to see if there's a tremor and other neurologic changes, which are really important in terms of neurocognitive disorders. Also for behavioral issues, if someone's in the comfort of their home I might not see the full expression of some of the behaviors that really need to be seen. Frankly, again, I use this term before, the power of presence--having someone there, shaking their hand, looking eyeball to eyeball, being able to interact with them, to schmooze with them and their family members in addition to the meeting. That's part of the connection you build with someone. I find with older individuals, they thrive on that, they need that. When you're looking at someone through a small screen, especially someone who has neurocognitive impairment and they really need that sensory stimulation, the sounds, the sight, the touches, all that, that really is lacking with telepsychiatry. So I might see a more apathetic, more withdrawn picture for someone where they might be more animated and more engaged when they come in the office.

So it balances out. Again, they're more accessible, I can see them more frequently and I find in general, with the family involvement, I get a lot more information and I see them more often. But again, I lack that presence. So there's a lot of people who I met and saw completely by telepsychiatry throughout the COVID pandemic, but once it was over, having them come in the office was really, really wonderful and I found it really helped to enhance the connection with them as a patient.

So what's the future? There's no question that telepsychiatry is here to stay. It's only going to expand. I think a lot of young clinicians are going to find that half or more of their practice is going to be by some form of telepsychiatry platform. I would imagine as technology improves, we'll be able to do a lot more, and that's really important, especially when older individuals, ways to enhance that sensory stimulation. So I think as this expands, we will be able to meet a lot of these needs. I may be old-fashioned with this, but still I think it's so important at some point to see someone in person, again, that presence can be so important. But without question, the field is evolving in a really positive direction and there's a lot to look forward to.

So wishing everyone the best of success with their practices. I hope this overview of telepsychiatry has been really helpful and look forward to talking to you on other topics having to do with geriatric psychiatry for the Psych Congress Network. Thank you so much.

Marc E. Agronin, MD, board-certified adult and geriatric psychiatrist, is the chief medical officer of the Frank C. and Lynn Scaduto MIND Institute and for Behavioral Health at Miami Jewish Health. Dr Agronin is an Affiliate Associate Professor of Psychiatry and Neurology at the University of Miami Miller School of Medicine. Being a national expert in Alzheimer disease and geriatric mental health, he serves as the Geriatric Psychiatry Section Editor for the Psych Congress Network.